MEDICARE: DR. ZAKIA K SIAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	4301090903	MI

General Provider Information

NPI Number	:	1295927440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAKIA K SIAL M.D.

Provider Business Mailing Address
First Line	:	3601 W TEDFORD DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-1034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 INKSTER RD
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1209
Country	:	US
Telephone Number	:	313-565-5506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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